Patient Health Literacies

In Arthur Frank’s (1995) seminal book The Wounded Storyteller, he cautions “On rare occasions when I have taught this book, students’ biggest initial difficulty is to stop reframing everything ill people say into a question of how some health-care worker might respond.” (Location 115)

I often find myself falling into that trap. I find myself thinking about my research, and the focus on peer-to-peer patient learning, and yet seem to feel that the value in the research is in the change in how health-care workers respond. Really, my focus should be a change in how my work can help patients and caregivers find agency within the healthcare system.

This idea of value of knowledge (or value of literacy) is something that Brian Street talks about in Social Literacies: The Schooling of literacy. I talked a little about it in my post on critical digital health literacy. In the chapter I’m reading now, Street (1995) talks about how the definition of what literacy is (the value proposition) is defined by the dominant culture. When we talk of a critical literacy, we are turning that around and looking at it from the perspective of the non-dominant – perhaps those who are seen as not literate.

In the health literacy context, we see the definition of digital health literacy from the perspective of healthcare systems –  “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem” (Norman & Skinner, 2008, para. 6). To me, this definition feels like what health professional want patients to have, not what patients necessarily want or need. The health literacy definition is from the perspective of the dominant culture. It is also very solution oriented – as if there were only one solution to the “health problem”. The human body is complex. It is a complex system. There are many different ways in which to approach a health problem, and not all of those involve solutions.

Now if I look at it from my perspective as a patient, and not a healthcare professional, I can see literacies in a different light. If I look at what I consider important to be “health literate” from a patient perspective, I’d say:

  1. Understanding the disease well enough to explain it to both non-medical professionals and medical professionals (knowing that the language of the medical profession is not the same as the language used by the general population).
  2. Understanding the healthcare system well enough to get the care you are looking for. This in part means knowing who to ask which questions to, and knowing even what things are available to you as a patient. Understanding the hierarchies within the healthcare system helps to ensure you are asking the right people the right questions.
  3. Knowing where to go to get support from peers.
  4. Knowing how to identify individual experiences of disease experience versus generalized experiences. That is, developing an understanding of what aspects are typical and what aspects are unique to the individual experiencing the disease.
  5. Understanding the disease well enough to search for information on the internet, and discern appropriate sources of information (e.g. being able to identify snail oil).

My question to you is, as a patient, what you see as the important things YOU need to know in order to manage your personal health? 

Feature image: By NASA/MSFC/David Higginbotham – NASA Image of the Day, Public Domain, Link

2 Comments on Patient Health Literacies

  1. Lots of food for thought here. I read a paper recently which said that approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. The study showed that patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful. I have received immeasurable benefits from using the Internet to manage my own health and that of loved ones, but it concerns me that such high numbers of individuals do not receive the full health benefits from these technological advances.

    • I think you can take “technology” out of the equation and still have the same issue. I do wonder if part of it is the inherently paternalistic healthcare system, and the fact that most family health is managed by the women in the family. So I wonder if there is also a large gender bias in health literacy. That is an interesting question in and of itself – I don’t know that anyone has studied it.
      I am more and more thinking about ways in which health literacy should be defined and studied from the patient perspective and not the healthcare provider perspective. I have a quote from Arthur Frank that you would like “students’ biggest initial difficulty is to stop reframing everything ill people say into a question of how some health-care worker might respond.” And health literacy has been studied with the same thought. Not about what the ill person needs but rather what the healthcare worker can do to improve outcomes. It makes me wonder if we need to be looking at things not from a healthcare worker perspective in order to affect change.

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